Peter C. Goodwin

Reliability of leg muscle electromyography in vertical jumping

Abstract In this study we aimed to determine the reliability of the surface electromyography (EMG) of leg muscles during vertical jumping between two test sessions, held 2 weeks apart. Fifteen females performed three maximal vertical jumps with countermovement. The displacement of the body centre of mass (BCM), duration of propulsion phase (time), range of motion (ROM) and angular velocity of the knee and surface EMG of four leg muscles (rectus femoris, vastus medialis, biceps femoris and gastrocnemius) were recorded during the jumps. All variables were analysed throughout the propulsion and mid-propulsion phases. Intraclass correlation coefficients (ICC) for the rectus femoris, vastus medialis, biceps femoris and gastrocnemius were calculated to be 0.88, 0.70, 0.24 and 0.01, respectively. BCM, ROM and time values all indicated ICC values greater than 0.90, and the mean knee angular velocity was slightly lower, at 0.75. ICCs between displacement of the BCM and integrated EMG (IEMG) of the muscles studied were less than 0.50. The angular velocity of the knee did not correlate well with muscle activity. Factors that may have affected reliability were variations in the position of electrode replacement, skin resistance, cross-talk between muscles and jump mechanics. The results of this study suggest that while kinematic variables are reproducible over successive vertical jumps, the degree of repeatability of an IEMG signal is dependent upon the muscle studied.

Physical therapy after arthroscopic partial meniscectomy: Is it effective?

GOODWIN, P. C., and M. C. MORRISSEY. Physical therapy after arthroscopic partial meniscectomy: Is it effective? Exerc. Sport Sci. Rev., Vol. 31, No. 2, pp. 85–90, 2003. Controversy in the literature has prompted clinicians to question the effectiveness of physical therapy after knee arthroscopic partial meniscectomy. Studies reviewed in this paper show there is little evidence that formal physical therapy is necessary to return patients to their normal activities of daily living, when compared with not receiving this care.

Evaluating treatment effectiveness: benchmarks for rehabilitation after partial meniscectomy knee arthroscopy.

Morrissey MC, Milligan P, Goodwin PC: Evaluating treatment effectiveness: Benchmarks for rehabilitation after partial meniscectomy knee arthroscopy. Am J Phys Med Rehabil 2006;85:490–501. Objective:The purpose of this study was to give a detailed description of recovery benchmarks that occur in patients whose therapy after partial meniscectomy knee arthroscopy consists of a home program of exercise. These benchmarks can be used as a basis for clinicians to compare improvements to individual patients who receive supervised care. Design:Thirty-nine patients (five females, mean age = 41) who underwent an uncomplicated arthroscopic partial meniscectomy were included. Test sessions occurred at 5 and 50 days after surgery. Outcome measures included: 1) Hughston Clinic knee self-assessment questionnaire; 2) EQ-5D Tariff for assessment of quality of life; 3) number of days taken to return to work after surgery; 4) knee passive range of motion; and 5) knee swelling assessed by evaluation of knee circumference. Stepwise regression analysis was used to evaluate factors that might have influenced the amount of pre- to posttest change in the outcome measures (the benchmarks) during the first 7 wks after surgery. The factors used in this analysis were: 1) age, 2) body mass index, 3) period from injury to surgery, and 4) the baseline value of the variable to be examined (except for return to work, where we used a score estimating the challenge to the knee offered by work). Results:None of the factors considered (age, body mass index, period from injury to surgery, stressfulness of the work on the knee) affected the number of days taken to return to work. Baseline scores affected change in all the other outcomes, and knee girth change was also affected by body mass index. Regression equations are presented where suitable for the benchmarks presented. Conclusions:Quick recovery occurs in these patients when only a home exercise program is given. This paper highlights the utility of using historical control group data instead of test-retest analysis of measurement error in evaluating patients whose recovery with a home exercise program is rapid. Of the variables analyzed in this study, quality of life and knee self-assessment changes offer the most useful benchmarks for evaluating treatment effectiveness.

Injury incidence in a Premier League youth soccer academy using the consensus statement: a prospective cohort study

Background There is an established risk of injury to young athletes exposed to high training loads. Identifying and monitoring injury risk is essential to aid prevention. The aim of this study was to use the consensus statement to determine the incidence and pattern of injury in 1 English Premier League soccer academy during 1 season. Methods A prospective cohort study included 181 elite academy soccer players during the 2012–2013 season. Players were divided into 5 age groups between 9 and 18 years. The number, type and incidence of injuries were recorded during matches and training. Incidence was calculated per 1000 hours of exposure. Results 127 injuries occurred during 29 346 hours of soccer exposure. 72% of injuries were non-contact related. Under (U)18 players sustained the highest number of match injuries. U12–14 players sustained the highest number of training injuries and injuries overall. U16 players sustained the highest number of severe injuries, and U18 players sustained the highest number of moderate injuries. U18 players sustained the highest number of injuries/1000 hours of training and overall. U15 players sustained the highest number of injuries/1000 hours of matches, the highest number of recurrent injuries and the highest incidence of recurrence. The most common injuries were muscle injuries in U15 and U18 players. The most common injury location was the anterior thigh, with the majority of these occurring in training. Conclusions Using the consensus statement, this study used a repeatable method to identify the injury profile of elite academy-level soccer players.

Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study

Objective To produce free, expert-informed postoperative information for lumbar discectomy patients, satisfying UK National Health Service Information Standards. Design A mixed methods approach utilising the Delphi technique and focus groups. Setting Five spinal centres across the UK. Participants Panel members included 23 physiotherapists, 11 patients and 17 spinal surgeons. Intervention Three rounds of questionnaires including open and closed questions and attendance at a clinician/patient focus group. Results Response rates of 85%, 26% and 35% were achieved for the Delphi rounds. Ten clinicians and six patients participated in the focus groups. Consensus for leaflet sections was achieved in round 1 and content in round 3. The focus groups informed further revisions. Conclusions A consensually agreed, Information Standard compliant, patient lumbar discectomy leaflet was produced containing: (1) normal spine anatomy; (2) anatomy disc herniation and surgery; (3) back protection strategies and (4) frequently asked questions. Illustrations of exercises enable tailoring to the individual patient.

Factors Related to Early Recovery Rate After Partial Knee Meniscectomy

A main role of clinicians treating patients after orthopedic surgery is to inform patients about their anticipated recovery rate and recovery endpoint. In estimating recovery rate, clinicians consider a series of potentially influencing factors, including the type and severity of injury and the characteristics of the patient. Unfortunately, this is done largely without evidence to support factors believed to be important in recovery rate. To our knowledge, no studies exist where factors that might influence recovery rate after arthroscopic partial meniscectomy have been evaluated. Eighty-three patients (11 women and 72 men) were evaluated 4 days after and then again 6 weeks after knee arthroscopic partial meniscectomy surgery. Recovery rate was calculated by dividing the change in a patients Hughston Clinic knee self-assessment questionnaire during this period by his or her baseline Hughston score and relationships to independent variables (gender, age, body mass index [BMI], injury chronicity, affected meniscus, Hughston Clinic knee self-assessment score at baseline, knee flexion passive range of motion, and knee circumference). These were evaluated using backward stepwise regression analysis. The relationship between recovery rate and the independent variables was statistically significant (P,.05) for the following variables: injury chronicity, gender, and gender/injury type combination. The most unexpected finding in this study was the statistically nonsignificant relationship between recovery rate and the following variables: age, Hughston score, BMI, knee swelling, and knee flexion passive range of motion loss.

Is there an association between back pain and stress incontinence in adults with cystic fibrosis? A retrospective cross-sectional study

BACKGROUND Back pain and stress urinary incontinence (SUI) are common in adults with cystic fibrosis (CF). This study aimed to establish whether there is an association between back pain, lung function and stress urinary incontinence and its relative risk. METHOD This was a cross-sectional, retrospective analysis of the Manchester Musculoskeletal Screening Tool (MMST) data. It includes pain, (Short Form McGill Pain Questionnaire (SF-MPQ and VAS)) and International Consultation on Incontinence Short Form (ICIQ-UI-SF) measures. Associations were tested using Spearmans rank correlation coefficient. Relative risk of developing symptoms was calculated the sig level was p=0.05. RESULTS ICIQ-UI-SF was associated with back pain (SF-MPQ) (Rho=0.32, p<0.001) and pain (VAS) (Rho=0.23, p<0.01). RR of developing SUI with back pain was 2; RR of developing back pain with SUI was 1.3. CONCLUSIONS An association is indicated between back pain (SF-MPQ and VAS), and SUI in adults with CF. This information is important when developing management strategies in the CF population.

Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report

Background/aim The distal tibiofibular joint is described as a syndesmosis. Traditionally, severe syndesmotic injuries with diastasis have been treated surgically with screw fixation. This case series details an ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol that reduces the amount of time to return to professional rugby league in the UK. The aim of this study was to describe players’ journey from injury, through diagnosis to surgery, rehabilitation and return to participation, detailing time scales and methods used at each stage to highlight the change in current practice. Methods Players were identified via a single orthopaedic surgeon in the UK who specialises in ankle syndesmosis repair. Between January 2010 and September 2015, adult men playing full-time professional rugby league in the UK Super League with ankle syndesmosis injuries were identified. Results Eighteen players from six different clubs were included. The most common mechanism of injury was forced dorsiflexion/eversion. The average return to participation was 64 days (SD 17.2, range 38–108). This compares favourably to reports of between 120 and 180 days following screw fixation. Conclusion Ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol is as safe as traditional methods. The accelerated rehabilitation protocol promotes early weight-bearing and has shown to expedite the return to sport for professional Rugby League players. It is possible to return to sport 2 months after a tightrope repair and accelerated rehabilitation, compared with 3–6 months post screw fixation. This is extremely encouraging for the professional sporting population.

Patient and physiotherapist perceptions of rehabilitation following primary lumbar discectomy: a qualitative focus group study embedded within an external pilot and feasibility trial

Objective To evaluate patients’ and physiotherapists’ perceptions, preferences and feelings about rehabilitation following lumbar discectomy surgery. Design A qualitative focus group study, informed from the theoretical perspective of phenomenology, of patients’ and physiotherapists’ experiences of rehabilitation following lumbar discectomy was conducted. The focus groups were used to explore patients’ and physiotherapists’ perceptions and their preferences and feelings about different approaches to rehabilitation. The focus groups were facilitated and observed by experienced researchers and were informed by a topic guide that had been piloted previously. Setting The study was embedded within an external pilot and feasibility trial that randomised patients across two secondary care spinal surgery sites in the UK to receive either 1:1 physiotherapy and leaflet or leaflet-only interventions. Participants Five focus groups took place between April and July 2014. A framework analysis of thematic coding (deductive and inductive components) by two researchers captured identified themes common to both patients and physiotherapists. Data from three focus groups with patients and carers (n=11) and two with physiotherapists (n=15) contributed to the analytic framework. Results Emerging themes included: the value of patient leaflets with or without physiotherapy interventions; the importance of self-motivation in the recovery pathway; benefits of group physiotherapy for some patient groups and patient preference influencing rehabilitation. Conclusion Patients and physiotherapists perceived the study patient leaflet and 1:1 physiotherapy interventions as high quality and valuable. Patients’ personal priorities, for example, their need to return to work, influenced their preferences for rehabilitation interventions following surgery.

Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study

Objectives To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice. Design Mixed-methods combining evidence synthesis, expert review and focus groups. Setting Secondary care involving 5 UK specialist spinal centres. Participants A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre. Methods A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified. Results The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists. Conclusions A rigorous process informed an optimised 1:1 physiotherapy intervention post-lumbar discectomy that reflects best practice. The developed intervention was agreed on by the 5 spinal centres for implementation in a randomised controlled trial to evaluate its effectiveness.